LIMPOPO MATHS AND SCIENCE ACADEMY

P.O. Box 270, MOKOPANE

0600.

Email:

Contact: 0833677320

WINTER SCHOOL CAMP 2017 APPLICATION FORM

LEARNERS DETAILS

SURNAME
FIRST NAMES
TITLE / GENDER / D.O.B / C / C / Y / Y / M / M / D / D
POSTAL ADRESS
CODE
TEL / CELL
LEARNER’S SIGNATURE / DATE / Y / Y / M / M / D / D

SCHOOL INFORMATION

NAME OF SCHOOL
CONTACT NUMBER
PROVINCE
DISTRICT
CIRCUIT
GRADE(please tick) / Grade 12 / Grade 11
Subjects registered. please tick.(only subjects appearing below will be offered at the camp
Mathematics / Maths literacy / Accounting / Sepedi HL
Life sciences / Geography / B. Studies / English HL
Physical science / Agric science / Economics / English FAL
How do you rate yourself? / Slow learner / Hard worker / Above average

PERSON RESPONSIBLE FOR PAYMENTS

SURNAME
FIRST NAMES
TITLE / I D NUMBER
POSTAL ADRESS
CODE
WORK ADRESS
(PHYSICAL)
CODE
HOME ADRESS
(PHYSICAL)
CODE
CELL / WORK T
RELATIONSHIP TO LEARNER
SIGNATURE / DATE / Y / Y / M / M / D / D

MEDICAL AND HEALTH INFORMATION

We would like to know about the learner’s ailment that needs special attention so that we can beable to respond accordingly in case of illness.

PLEASE NOTE THAT THE INFORMATION SHALL BE KEPT IN STRICT CONFIDENCE.

Any ailment that we should know

HOW SHOULD LiMSA RESPOND IN THE CASE OF THESE AILMENT ATTACKING THE LEARNER UNDER OUR CARE.PLEASE TICK BELOW

Phone the parents / Take the child to the clinic or hospital
Phone the doctor / Doctor’s contact no
Perform the following first aid

GENERAL INDEMNITY

THIS SECTION MUST BE COMPLETED STRICTLY BY PARENT/GUARDIAN

I, the undersigned

______

(Full names and surnames of parent/guardian) (Identity numbers)

In my personal and or representative capacity as a parent/guardian of

______

(Full names and surnames of the learner) (Identity numbers)

DO HEREBY DECLARE and certify irrevocably as follows:

  1. All particulars given by me in the form are true and correct.
  1. I will acquaint myself with the rules and regulations of LiMSA and will abide by them.
  1. I shall pay for the repair or replacement of any lost or damaged school property.
  1. I shall positively respond to any request by the LiMSA, e .g. disciplinary hearing etc.
  1. I allow LiMSA staff and tutors to use their discretion to send my child to hospital or

clinic in case of illness and I shall pay all the financial expenses thereof.

6. I am aware that winter school camp fees and legal costs will be recovered from me

should I fail to fulfill my financial commitments towards LiMSA.

  1. I accept full responsibility for the payment of all tutoring, accommodation fees as well as any other fees determined by LiMSA.

8. That in cases where no fault can be attributed to the school, I hereby indemnify, absolute and hold harmless the LiMSA,its staff,student and invitees in respect of any damage to the property,death or bodily injury to /of myself and /third parties, whether on or off the winter school premises ,or whilst engaged in any activity related to LiMSA

NB: ANY FORM OF MISBEHAVIOUR WILL NOT BE TOLERATED.

CULPRITSWILL BE EXCUSED FROM THE PROGRAMME WITH IMMEDIATE EFFECT AND WITH

NO REFUND!HENCE WINTER SCHOOL FEE IS NON REFUNDIBLE ONCE IT IS PAID

NO VISITORS WILL BE ALLOWED DURING WINTER SCHOOL CAMPUNLESS OTHERWISE!

ALL LEARNERS WILL LEAVE ON THE LAST DAY OF THE CAMP UNLESS OTHERWISE

PARENT/GUADIAN SIGNATURE / DATE / Y / Y / M / M / D / D
LEARNERS SIGNATURE / DATE / Y / Y / M / M / D / D
WITNESS SIGNATURE / DATE / Y / Y / M / M / D / D

GENERAL INFORMATION

LiMSA WINTER SCHOOL CAMP 2017

LiMSA invites all CAPS grade 11 and 12 learners to attend Winter School Camp that will start from 02JULY to 15July 2017(Two weeks).

VENUE:” LIMSA EDU CENTRE

  • The camp amount to R 1790 which includes , Accommodation, catering, study materials and tutoring fee , security etc.
  • An amount of R100 is payable when collecting an application form which forms part or it is

included in the Winter School Camp fees of R 1790.

  • A final payment of R 1690 should be deposited in the following account before 25thJune2017.

The subjects offered at the winter school camp areas follows:

Sepedi, English, Physical science, Accounting, Economics, Life science, Business studies,

Geography, Agricultural science, Mathematics, Maths literacy and Life skill/motivation

WHAT TO EXPECT AT THE WINTER SCHOOL CAMP.

  • Subject experts, Individual attention from experienced Tutors and Teachers, Study materials, Awards, Methods on how to study and answering questions, EXAMINATION TIPS.

LiMSA banking details

FOR OFFICE USE ONLY
PAYMENT / STATUS
COMPLETE
INCOMPLETE

Bank: FIRST NATIONAL BANK

Name: LIMPOPO MATHS AND SCIENCE ACADEMY

Account No: 6267 828 0597 (cheque account)

Reference : WSC Name of Learner

Branch Name: MOKOPANE

N.B PLEASE KEEP THE DEPOSIT SLIP AS PROOF OF PAYMENT

LEARNERS ARE EXPECTED TO BRING ALONG THE FOLLOWING:

  • Original receipts as proof of payment
  • Bedding (blankets, sheets and pillow)
  • Study materials (own textbooks, writing books, pens, calculator, pencils, etc.)
  • Eating utensils (plate, cup, spoon, etc.)
  • Something to wash in .

FOR MORE INFORMATION CONTACT: Klaas Masalesa @083 367 7320 OR 079736 5933

LiMSA !!THE BEST EDUCATIONAL PROJECT IN THE PROVINCE AND COUNTRY

“Through maths we prove, through science we discover”